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IMO AGM Pre Conference Coverage

Signing up for Respect

On the eve of the IMO’s 2017 AGM, the organisation signed-up to the new ‘Respect Charter’. David Lynch looks at the initiative

A year ago, when he first became IMO President, Dr John Duddy used his incoming address to highlight bullying and undermining behaviour towards young doctors.

“Throughout the year since, I have had people contacting me directly themselves with their own stories of bullying and thanking me for raising the issue,” Dr Duddy tells the Medical Independent (MI).

The outgoing IMO President said the recent signing of a new ‘Respect Charter’ by the IMO, the Forum of Irish Postgraduate Medical Training Bodies and the HSE was one of the “highlights” of his year as President.

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Pictured clockwise from left: Chair of the Forum of Irish Postgraduate Medical Training Bodies Prof Ellen O’Sullivan; RCSI President Prof John Hyland; IMO President Dr John Duddy; IMO Consultant Committee Chair Dr Peadar Gilligan; and HSE National Director of Human Resources Ms Rosarii Mannion 

The new Charter commits these bodies to stamping-out unacceptable behaviour towards doctors in training. 

A motion due to be debated on Friday morning (21 April) at the AGM welcomes “all signatories to the Respect Charter and calls on the HSE and Department of Health to work with the IMO so as to progress the principles laid out in the Charter, thus leading to a safer and healthier working environment”.

Since his speech last year, when he spoke of his own personal experience of being undermined as a trainee doctor, Dr Duddy says he has been “contacted by a few colleagues who had left the country because of their experience of bullying in work”.

He continued: “They also thanked me for raising and addressing the issue. Certainly, the feedback from other NCHDs was very positive as well.

“I think doing something like this [Respect Charter] publicly with the HSE and the training bodies is very positive. We have got three respected organisations that doctors are intimately involved with, saying publicly ‘this behaviour is unacceptable and unprofessional and we are going to work together to address it’. I think that is something I am very proud of.”

Also speaking at the launch of the Respect Charter, Prof Ellen O’Sullivan, Chair of the Forum of Irish Postgraduate Medical Training Bodes, said that “the mistreatment of medical students, trainees and indeed of any NCHD goes against the core tenets of professionalism that underpin the profession of medicine.

“It is the responsibility of training bodies and our trainers that there is a supportive learning environment.”

Prof O’Sullivan said all parties needed to take greater responsibly, “particularly those of us in leadership positions in our respective professions with regard to our role in changing behaviour.

“A number of training bodies are working towards strengthening and auditing their mentoring programmes to ensure they are effective and efficient. We must deal with this in a proactive manner and implement measures over bullying and harassment in the workplace. Such behaviour must not be tolerated and is totally unacceptable.”

Ms Rosarii Mannion, National Director of Human Resources at the HSE, pledged the Executive’s support for the new Charter. Ms Mannion pointed to the HSE’s ‘People Strategy’ and ongoing work on a new document looking at doctors’ health as supporting actions in this area.

At the launch, MI asked who a doctor should approach when experiencing bullying — the union, the training body or the Executive? All three representatives said they were not prescriptive on this, adding that they believed it was just very important that a doctor in that situation should contact someone to raise their concerns.

“We know that 35 per cent of trainee doctors have reported [in research of] being bullied or harassed at work,” said Dr Duddy, who also highlighted the high number of doctors who do not report cases.

“It is clearly an issue in the Irish health service. We are sending a message with the Respect Charter that this is a statement of principles from the three bodies that this behaviour is unacceptable and unprofessional. By sending a strong public message like this, we want doctors to come forward if they have experienced these sorts of problems at work. If people are experiencing this, they should come to the IMO, HSE or come to your training body.”

According to the IMO, research shows that trainees who were bullied are more likely to say they intend leaving medical practice in Ireland.

“This Respect Charter clearly demonstrates that we all recognise there is a problem and working together, we are determined to change the culture and improve the experience of our trainees,” said Dr Duddy.

“There are inherent pressures and stresses in training to be a doctor but unacceptable behaviour need not be one of them.” 

A copy of the Respect Charter can be found at www.imo.ie/news-media/news-press-releases/2017/imo-joins-with-hse-to-lau/index.xml

Doctors in motion

The IMO has a bumper list of motions for its upcoming AGM. David Lynch spoke to leading union members about what will be on the agenda in Galway

With his term as IMO President coming to a close, Dr John Duddy cites the raising of awareness around bullying in medicine and a “significant” achievement in industrial relations (IR) as two highlights of his year as IMO President.

The Medical Independent (MI) sat down with Dr Duddy in his final days as IMO President.

 “I think you can look at it in two ways. First, the IR agenda, which is always important for the organisation, and secondly the more, what I would call, general issues facing the profession,” Dr Duddy tells MI.

“This would be my number one issue I be most proud of — getting the Respect Charter off the ground. I identified it as a key issue at the AGM last year. But with the IR agenda, clearly the biggest achievement for us was the restoration of the Living Out Allowance.

“Resolving that issue that was running on for far too long — I think everyone in the organisation was delighted to get that resolved in a positive fashion. We effectively got a pay raise in July for 4,000 doctors and that is something we can all be proud of. I mean, the whole team here worked really well on that.”

The IMO has already published a long list of motions for the upcoming AGM on its website. Dr Duddy, who is a Specialist Registrar in Neurosurgery at Cork University Hospital, has proposed a number of motions.

A motion that will be voted on in the General Motions Session on Friday morning (21 April) looks at the need for regulation of healthcare managers. It calls on the Department of Health to “establish, on a statutory basis, an Independent Regulator to ensure all health managers in the context of delivery of health services are held to the same standard of regulatory oversight as doctors”.

Dr Duddy has co-proposed this motion with the North Dublin GP Branch and Dr Tafadzwa Mandiwanza.  The IMO President told MI he believes such independent regulation is important for two reasons.

“Firstly, because managers take decisions that impact patients, just as doctors and nurses do,” he said.

“And doctors and nurses are subject to very stringent oversight and regulation by their respective bodies. So why would a manager or someone in a position of authority who is making budgetary decisions that could affect patient care not be subject to the same regulation?”

However, Dr Duddy also points to a “double standard” that is currently in place following changes to the Medical Council guidelines.

“The other thing as well, the new Medical Council ethical guidelines that came out in 2016 have a specific section on doctors in management roles,” said Dr Duddy.

“And it says if a doctor is in a management role and they take decisions that affect patient care, they can be subject to sanction by the Medical Council.

“They are expected to uphold the same standards of professionalism and patient safety that they would if they were practising clinically. So that means there is a double standard there.

“If you have a doctor in a management position versus a non-doctor in a management position, that doctor can be struck off the medical register and lose their job because of a decision they make as a manager. But a manager from a non-medical background is not subject to that kind of regulation.”

During the General Motions Session on Saturday (22 April), Dr Duddy has proposed a motion calling on the Government to reopen “closed hospital wards in order to address emergency department overcrowding” and another motion to increase capital spending in the acute services.

For a doctor working in the hospital sector, these aims are understandable, but does he worry that the recent talk of a ‘shift’ to primary care in the health service may mean less focus and funding for acute care in the coming years?

“I don’t think so. It depends how you look at it and I try to look at it as a bigger overall picture,” says Dr Duddy. “If you have that shift to primary care, the long-term savings you get from that will be able to fund what’s required in the acute sector. 

“There is always that thing people say, [that] hospital doctors don’t want GPs to get these resources because they will take from the hospital. I personally don’t believe that. I think, personally, it can be done in a way that is shared.

“The integrated care model that is being developed, I think we need to almost break down that barrier where we see funding in this pot for primary care, and funding in this other pot for hospitals.

“If you have an integrated system where you have funding for care for the patient, rather than it being for the hospital or the primary care setting, I think that’s the model we need to go towards.”

The Cork-based doctor says he hopes that the focus on specific areas of health provision may be coming to an end, with a more “integrated” view taking its place.

“I have colleagues in Cork who are developing a programme like that at the moment. [They are] looking at funding for the patient, rather than funding for the hospital or the GP.

“Long term, we need this shift to primary care. It won’t happen next year or the year after, but five, 10, 15 years down the line. Then we will see the reduction in hospital admissions, reduction in the requirement for expensive hospital treatments happening, so that will improve the overall resources and funding situation for both acute and primary care.”

The 2017 IMO AGM will take place in the Radisson Blu Hotel and Spa, Galway, from Thursday, 20 April to Sunday, 23 April 2017. The theme for the AGM is ‘Our Health Services — Dying for Investment’.

Minister for Health Simon Harris is due to address delegates on Saturday at 2pm.

NCHD meeting will highlight financial concerns

The NCHD Committee of the IMO meets on Saturday morning (22 April) at the AGM, and it is clear that financial concerns will inform much of the discussions.

The first two motions scheduled to be debated deal with the cost of training for young doctors. One motion calls on the HSE to “fund all mandatory training courses in full up-front”.

Another motion calls on the Executive to “increase its refund list to include all exams and courses necessary for training and provide full refunds for NCHDs undertaking them”.

Chair of the union’s NCHD Committee Dr Paddy Hillery told MI that the cost of mandatory training, exams and attendance at international conferences all “accumulates”.

This is set against the backdrop of an improving situation regarding NCHD working hours, but a resulting drop in overtime payments. “We have had positive discussions through the MacCraith Group and with the HSE to engage in this,” Dr Hillery tells MI.

“There have been no solid outcomes following these engagements as yet, although the IMO is positive, and will actively engage and try to push this situation forward.”

Dr Hillery says training “is one of the key issues for NCHDs across the country”.

He outlined: “They want to be able to progress and get more experience. This needs to be funded; it cannot be purely dependent on the ability of NCHDs to save thousands a year just to spend on courses.” The NCHD Committee Chair said he has also experienced the cost of examinations, courses and conference attendance. “Although I have been involved in a relatively small number of courses, [they] cost me in excess of €2,500-€3,000 over the last year,” he said. “It is a significant deficit on what is a NCHD’s take-home package.”

He added that the IMO is open to discussions over how to deal with this funding issue. “There are many ways they could adjust this. The best way, I would see, would be some training supports from the HSE, or other issues such as tax reductions; making these payments tax-deductible would be beneficial.

“That is what we are hoping to engage the HSE and the Department of Health on, and we hope over the next couple of months, with this positive engagement, we will get a positive outcome.”

Salaried GPs a ‘quick fix’

Niamh Cahill

The introduction of salaried GPs in response to GP shortages in certain areas is not the best solution for patients or GPs, according to a motion tabled for debate at the forthcoming IMO AGM.

Proposed by Carlow GP Dr Pascal O’Dea, two motions on the issue state that a new fit-for-purpose GP contract is what is required as a long-term solution to GP shortages.

The motions were made following suggestions that the introduction of salaried GPs could be used to address GP shortages in deprived rural and urban areas, Dr O’Dea told the Medical Independent (MI).

Meanwhile, a motion tabled by the Sligo branch has called for a salaried option as part of the proposed new GP contract to facilitate the survival of GPs in marginal areas.

However, Dr O’Dea believes that this “quick fix” solution has not been thought out and no details of the specifics of such an arrangement — for example, pension issues — have been provided to date. “The idea needs to be fleshed-out more. Generational continuity of care for communities is what general practice is all about and salaried GPs might lend itself to more turnover of GPs, unless properly resourced,” Dr O’Dea stated.

Clare GP Dr Michael Kelleher, who seconded Dr O’Dea’s motions, told MI that there was no appetite among the Department of Health for all GPs to have salaries, as pension costs would be huge. Dr Kelleher added that if a sustainable and viable contract was in place, more doctors would be attracted to urban and rural deprived areas.

Thiamine proposed as reimbursable drug

Niamh Cahill

The Department of Health and the HSE should include thiamine as a reimbursable drug under the GMS Payments Scheme to help limit costs for vulnerable patients detoxing from alcohol, a Dublin GP has advised. 

A motion proposed by Dr Kieran Harkin at the upcoming IMO AGM calls for the drug’s reimbursement. It is seconded by Dublin GP Dr Austin O’Carroll. Dr Harkin, who works with the homeless, said the vitamin is essential for people recovering from alcohol addiction, as without it, patients can develop a permanent memory deficit. Korsakoff syndrome, a chronic memory disorder, is caused by a deficiency of thiamine and is commonly seen in patients who misuse alcohol.

But thiamine costs about €12 for a monthly dose, Dr Harkin stated. “Many patients are not willing to pay this. A lot of my patients are homeless and they simply don’t have €12,” he said.

Will the Future of Healthcare be bright?

Vanessa Hetherington

At the end of April, the Oireachtas Committee on the Future of Healthcare is due to publish its report laying out a single, long-term vision for healthcare and the direction of health policy in Ireland. Recent media reports suggest the report, when it is delivered, may still underestimate the key challenges that face our health system — namely, how to enhance service provision and manpower capacity to meet the needs of a growing population and changing demographics, the recruitment and retention of our highly-qualified medical workforce, and the financing of universal healthcare.

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Ms Vanessa Hetherington

Earlier this month, the national media widely reported that the Committee’s report will include recommendations to expand free GP care to half a million citizens each year, 12-week waiting times for inpatient procedures, 10 weeks for outpatient appointments, 10 days for diagnostics and a four-hour target waiting time in our emergency departments. The media also reported there will be a significant drop in out-of-pocket payments for care, the treatment of private patients in public hospitals will come to an end, and there will be a new health card introduced entitling citizens to healthcare based on need.

Over the last six months, the Oireachtas Committee has consulted with a wide range of stakeholders, including the IMO. In a detailed submission and meeting with the Oireachtas Committee on the Future of Healthcare, the IMO highlighted the capacity issues across the health system and the urgent need for investment in key areas, including general practice, consultant-delivered hospital care, acute bed capacity, long-term care, mental health, public health capacity and IT systems to ensure a 21st Century healthcare system that meets the needs of a growing and ageing population.

GP care is the cornerstone of a modern healthcare system. In order to expand GP care, free at the point of access to the whole population, it is estimated that Ireland will need an additional 2,055 GPs by 2025, a new modern GP contract and significant investment in infrastructure. So far, we have yet to hear the Committee’s recommendations to develop general practice.

The Committee reportedly envisages an additional 600 consultants will be recruited in year four, despite the fact that an estimated 1,920 additional consultants will be needed over the next 10 years to provide a consultant-delivered hospital service and currently, the HSE is unable to fill one-in-eight consultant posts. Taking into account both public and private beds, Ireland would need an additional 3,500 beds to bring us up to the west European average, but so far we have no idea how many additional hospital beds the Committee envisages, nor what capital investment is required. 

Apart from recruiting 900 additional nurses in the community, we do not know yet how the long-term care needs of the elderly are to be met, nor do we know what resources are to be allocated to mental health services. The health and wellbeing budget is to be doubled, but so far we have no detail on whether public health expertise is to be expanded or what investment is to be made in information systems.

It has been reported that an estimated €5.4 billion will be needed over the next six years, to include €400 million per year in additional service funding and €3 billion transitional funding, but as yet there is no indication how the additional funds are to be raised. A new fund will replace the €621 million income to the public system from private health insurers, but again, we have no detail on where that funding is to come from.

Access to care in Ireland is a capacity issue. Almost a decade of funding cuts and under-investment has left Ireland’s healthcare system bursting at the seams. Emergency department overcrowding and waiting lists reach new record levels each year. We have yet to see the final report of the Oireachtas Committee but let us hope the report shows a real future for healthcare, one where all citizens have access to quality, affordable care when they need it.

However, unless the report seriously addresses issues of capacity and medical manpower, and provides for substantial investment in health services, that goal may remain a long way off.

Ms Vanessa Hetherington is IMO Assistant Director, Policy and International Affairs

Delivering first-rate care to patients in the community

Dr Ann Hogan

Community health doctors deliver a range of vital primary care medical services. The emphasis in community health medicine is on the maintenance of good health through preventative medicine and early intervention programmes.

Community health doctors are employed by the HSE in all areas of the country to treat a patient population that, while largely comprised of infants, pre-school and school children, can include any and all other patients, including some of our most vulnerable citizens.

Community health doctors take a holistic approach to patient care, both in large-scale public health initiatives, of which the HPV cervical cancer vaccine programme may be the highest profile, or in responding to individual referrals. Community health doctors also provide medical expertise to a number of national programmes and projects, including serving in both an advisory role and providing independent medical input and assessments.

This culture of community health medicine is one of partnership in terms of enabling individuals, families and communities to be at the centre of service planning and delivery. As a result of this structure, community health doctors have a comprehensive knowledge of services available to their patients and are very well placed to make timely and appropriate onward referrals to hospitals or therapeutic services.

Since the onset of the financial crisis, community health doctors have continued to deliver first-rate community-based patient care, despite limited resources. Community health doctors have come to feel that they rarely appear on management’s radar, other than to be in the firing line.

This is especially so in respect of the remaining area medical officers (AMOs); despite the strenuous effort and investment of the IMO in working towards a resolution to their case, health service management remain as unyielding as ever. In dragging this matter out, and dragging individuals to the courts, the management side have behaved shamefully.

Nevertheless, despite this, community health doctors, including AMO colleagues, have consistently demonstrated they are efficient, dependable and essential resources. The steep reduction in funding for the health service and exhortations that ‘more must be done with less’ have severely affected community health medicine. However, despite the challenges presented by reduced staff numbers, which were never optimal to begin with, increased workload and a decline in resources available, community health doctors have ensured that patients continue to enjoy an expert, quality service within the constraints of available resources.

I would argue that now is the time for the management of the health service to ‘think smart’ and recognise that community health medicine represents an excellent value proposition as a community-based specialist service. As a community-based service, specialising in prevention and embedded in primary care, an enhanced community health medicine service could play a key role in the delivery of health services.

Community health doctors play an integral role in primary care. For example, these doctors could lead the development of a child health service, including a school health service. In addition, quite a few community health doctors are interested in branching-out into areas of health promotion, including helping to curb the obesity epidemic and providing appropriate medical input to medical colleagues on topics of expertise, such as immunisations. Many doctors envision increased roles in paediatrics, for instance, with appropriate upskilling and/or training opportunities. Additionally, some doctors would like to take on an increased advisory role and should be given the opportunity to be included in national groups and policy-making in areas of expertise, such as the disability services.

All of these changes, however, require that the supports be put in place. Community health doctors need flexible access to a specialist training programme and need to be recognised as members of a faculty. They must to be offered the opportunity to upskill and to undertake training in relevant, focused areas to expand the services they offer, in line with their professional development needs, and in response to the needs of the community in which they work.

Community health doctors have a wealth of knowledge and experience and they are well placed to ensure that health services are delivered in an inclusive manner, with a focus on preventive care. This in turn should ensure a healthier, happier population and reduce healthcare spending through a proactive approach to the health of the population.

Dr Ann Hogan is incoming IMO President

  

Zika awareness campaign is needed — IMO

DAVID LYNCH

The Public Health and Community Health Committee of the IMO is urging Irish health authorities to increase awareness around the Zika virus, particularly among women “in the reproductive years”.

Last November, the World Health Organisation (WHO) declared the end of the Public Health Emergency of International Concern in relation to Zika.

However, alongside this declaration, the WHO added that Zika remained “a significant, enduring public health challenge requiring intense action”.

The IMO Committee has a motion before the union’s upcoming AGM, calling on the Department of Health and HSE to implement a communications initiative to ensure “sustained, heightened awareness and appreciation” of the risks of Zika virus infection to women in the reproductive years.

 “This initiative should ensure that women (or their partners) would be fully aware of the risk to their unborn children if they (or their partners) become infected with Zika, and should highlight the risks they face if they (or their partners) travel to areas where Zika virus is being transmitted,” according to commentary provided to the Medical Independent by Dr Mary O’Riordan, Specialist in Public Health, Health Protection Surveillance Centre.

  

Making general practice a viable option for young doctors

Val Moran

Over the coming years, Ireland is facing a significant shortfall between the future demand for GP services and the future GP workforce available to meet this demand. Over 11 per cent of GPs are aged over 65, with 36 per cent aged over 55.

One of the key issues facing the health service now and into the future is to ensure that capacity in general practice is increased, both in terms of GP numbers and in relation to support staff, in order to meet the predicted increased demand of our growing and ageing population. It is therefore vital that general practice is a viable option for young GPs and that we put in place specific measures that will both retain our GP trainees on completion of their training, but also to attract back to Ireland those who have already left.

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Mr Val Moran

At present, there are little or no incentives for young GPs to establish as principals. General practice in Ireland is not seen as a viable option, with many choosing to go abroad and work in other systems that offer better prospects and greater security. 

The capacity problem in general practice requires a twin-track approach, the objectives of which should be to retain our current population of GPs, enable them to take on assistant GPs into the practice and ensure that newly-established GPs are supported. The two key elements toward tackling this problem are:

A GP contract that is sustainable, viable and professionally rewarding; and

Targeted supports to retain GP trainees and support newly-establishing GPs.

The new GP contract must reflect the true costs of practice, the actual workload, the capacity and the infrastructure required to deliver a quality service. It must provide funding and resources for general practice to develop to its full potential in terms of the scope of services that can and should be provided within general practice but can only happen in the context of adequate resources. It must support GPs in dealing with patients rather than paperwork; the current level of administration is a significant burden on individual GPs, taking up to an additional day within the working week. Critically, it is not realistic to expect GPs to take on the financial burden of a 24/7 GP service to the entire community and a radical reconfiguration of how out-of-hours services are funded is required. Any new contract must recognise the changing work patterns that prevail within society today and allow for flexibility, family-friendly initiatives and work/life balance.

In the context of the negotiations on a new GP contract, we need to bring in measures to alleviate the capacity problem in general practice and provide a future for our GP trainees and newly-established GPs. Until the capacity issue is dealt with, there can be little hope of significantly increasing workload within the scope of existing capacity.  

Given the demographics of the current GP population and the ever-increasing workload, there need to be supports to enable existing principals to employ assistants on a sound financial footing. This allows the younger GP a path into practice without necessarily tying them to a GMS list and, crucially, enables succession planning.  Such a measure would be flexible and not overly-prescriptive, handing the control to the GP practices so as to suit the individual circumstances and arrangements.   

GPs should be incentivised to develop their premises through capital allowances or other tax incentives that could be applied. For those who have already invested in premises, capital allowances should be established. At present, the incentive is in fact to keep the cost of premises as low as possible, as there is no financial benefit to developing the practice. This situation needs to be reversed and those who invest in premises should be enabled to do so.

It is essential that we tackle these issues now and create a new GP contract that will enable our current GPs to maintain and develop their practice and encourage our younger GPs to either take on existing practices or establish new practices. If we truly want to reverse the trend of early retirements, burn-out, emigration and lack of confidence in the future, we must take this opportunity to effect real change.

There is now an emerging consensus that there must be a ‘decisive shift’ to primary care but in order for this talk to become a reality, concrete resources and incentives must be put in place to allow general practice to deal with current and future patient demand in a secure, well-resourced environment.

Mr Val Moran is IMO Assistant Director, Industrial Relations

  

The road ahead: Working towards a new consultant contract

Anthony Owens

It has been said that ‘the past is another country’; rarely has that been truer than when one considers the bewildering speed with which the Irish economy went from illusory boom to very real bust in late 2008, and into early 2009.

Of course, the most recently-negotiated consultant contract arrived on the scene just before the crash, coming as it did in the summer of 2008. That contract was the product of a long, and sometimes bitter, process of negotiation. It was also very much a creature of its time.

As I am sure readers will remember, the employer sought to design the 2008 contract to place a cap on private practice and to ensure that consultants devoted more of their time to public work. Then, as now, consultants were unfairly blamed for waiting lists; the mantra of the time was that supposedly absent consultants, rather than closed wards and beds, were to blame for the ills of the health service.

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Mr Anthony Owens

However, the IMO has called for negotiations to commence on a new consultant contract, one that is fit-for-purpose and reflects the health service as it is today. With that in mind, it is worth considering just some of the elements that might go to make up a new contract.

Firstly, in light of the unprecedented number of consultant vacancies in the public system, a new contract should act as an incentive to medical specialists to stay in the system, or for those who have left to consider returning. The growth in the number of vacant consultant posts can be traced directly to the swingeing pay cut imposed on so-called ‘new-entrant consultants’ in October 2012. The IMO, in its submission to the Public Service Pay Commission, called for that cut to be reversed, and that needs to happen if we are to incentivise doctors to take posts in the public health service. That reversal could occur in the context of a new contract.  

Secondly, the still onerous on-call responsibilities of many consultants needs to be tackled. As long ago as 2012, health service employers promised to move to eliminate any roster more onerous than one-in-three. Of course, employing more consultants to remove onerous rosters is made problematical, when, at the same time, the pay of those very consultants is subject to an unfair and unilateral reduction. Nonetheless, onerous rosters need to be addressed.

Thirdly, a new contract must pay consultants for the work that they do, and recognise when they do that work. It is recognised that consultants are required to be flexible in the delivery of their service. However, consultant flexibility is demanded by an inflexible system. More and more, employers expect consultants to deliver services on five days out of seven, with no recognition that there are premium payment arrangements in place. It is doubtful that any other staff group in a hospital would tolerate being denied premium payments to which they are contractually entitled, with the expectation that they would then stay silent on the subject.

Again, I would note that the very consultants expected to provide the additional manpower that would allow full service across the seven-day period are the very doctors who suffered an unjust pay cut and who feel most alienated from the public health system.

Finally, the greatest hurdle to be overcome might be the first hurdle that we arrive at. Over the last number of years, there has been an almost total erosion in the trust that consultants will need to have in their employer to negotiate a contract. Today, nine years after the contract was negotiated, consultants are forced to seek recourse to the courts to have it honoured. On an ongoing basis, consultants are denied the tools necessary to do the job for which they have been recruited. Daily, consultants perform the same job but on very different pay scales. All of this occurs against a backdrop that still seeks to blame consultants for the ills of the health system.

In order to convince consultants that a new contract, one that is fit-for-purpose, is possible and should be negotiated, the first barrier to be overcome is a trust barrier built by the HSE and the Department of Health, under the watchful eye of the Department of Public Expenditure and Reform.

Consultants won’t be found wanting when negotiations commence — we will robustly negotiate on our own behalf, but most importantly on behalf of the standard of patient care that we want to deliver. It is to be hoped that we won’t engage in dialogue with an employer that just will not listen. 

Mr Anthony Owens is IMO Assistant Director, Industrial Relations

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